Use of Alcohol by Pregnant Women in the UK and Its Lasting Effects - Research Paper Example

?Research Proposal on the use of Alcohol by Pregnant Women in the U.K and its Lasting Effects Introduction While it is widely accepted that heavy alcohol drinking during pregnancy is detrimental to the health of the fetus, the effects of low and moderate drinking are still in question and research findings on these are inconclusive and confusing. This has generated differing guidance provided by healthcare organizations on the safe drinking threshold for pregnant women. This literature gap shows that the effects of low and moderate levels of alcohol consumption have been investigated by researchers as part of a wider range that includes high alcohol consumption. This paper responds to this uncertainty by focusing on the effects of low and moderate fetal alcohol exposure. Objectives The aim of this study is to evaluate the drinking experiences of pregnant women and identify the lasting effects of low and moderate prenatal alcohol exposure. The specific objectives of the study are; To ascertain low-moderate prenatal alcohol exposure as a risk factor for childhood, adolescent and adulthood behavioral, intellectual and emotional problems. To identify the main motivators to drinking during pregnancy. To assess the development and mental health of children born to mothers who abstained from drinking for the first trimester but drank alcohol in lightly or moderately for one or two of the remaining trimesters. To assess the mental health of children born to mothers who drunk an average of less than a unit of alcohol per day and those who drank 1-2 units of alcohol per day all through or most of their pregnancy. Literature Review Over the recent years, the proportion of women in the UK in their child-bearing age who take more over 14 units of alcohol weekly has been on the rise (Rickards et al 2004). Consequently, there has been an increasing interest about the potential mental/intellectual, behavioral and emotional health risks of prenatal alcohol exposure on human offspring. Specifically, there has been a huge controversy as to whether or not there exists a safe threshold for alcohol taking during pregnancy and whether the existing international policy recommendations on the same are based on evidence. Such information is of interest given the many cases that evidence negative long-term effects of alcohol on babies exposed to alcohol before birth. In addition, there have been publications and press releases that counter the call for pregnant women to abstain from alcohol. Some of these even promise a slight developmental advantage for kids exposed to alcohol before birth. Alcohol is a toxin and when taken in by a pregnant mother, it rapidly crosses the placenta and interfere the development of the fetus (Gray and Henderson 2006). There are more conclusive evidences associated with high levels of alcohol drinking by pregnant mothers. Mainly, this is damage to the nervous system. It causes brain damage and kills nerve cells resulting to lifetime problems in coordination, movement and learning. Sokol et al (2003) state that at the extreme end, these manifests as fetal alcoholic syndrome (FAS). FAS is a permanent birth defects disorder that affects children exposed to alcohol before birth. In particular, FAS has been linked to heavy drinking especially during the first three months of prenatal development (Alvik et al 2006). Full-blown FAS is the extreme manifestation of a spectrum of disorders related to heavy prenatal alcohol exposure. These disorders include facial defects, small birth weight and stunted growth. Generally, such children exhibit poor coordination, language development, behavioral problems and learning difficulties all their lives. According to Ulleland (1972), alcohol crosses the placenta and can stunt fetal weight or growth, damage brain structures and neurons, cause distinctive facial stigma and cause other physical, behavioral and mental problems. In the US, FAS prevalence is about 1% of all live births (Sampson et al 1997) and in the UK, this figure is estimated to be 2-4% of all live births (May et al 2006). Moderate alcohol consumption, 1-2 units daily, has equally been linked to fetal damage (Andreasson and Allebeck, 2005). Children affected by this level of prenatal alcohol consumption are described as suffering from alcohol-related neurodevelopmental disorder (ARND). This manifests as inattention, behavior and learning problems and overactivity. The effect of this on childhood behavior and attention has also been confirmed by Hill et al (2000) and Burden et al (2005). According to a study conducted by Abel and Sokol (1987), fetal alcohol exposure was found to be the leading cause of mental retardation in Western world countries. In addition, moderate fetal alcohol exposure has been linked to alcohol-induced interruption or disruption of endocrine signaling. Ronis el al (2007) identified this as insulin-like and brain insulin growth factor resistance. However, most of these studies are still inconclusive and thus unhelpful in making policy recommendations. Low drinking ranges from occasional drinking to less than one unit/glass per day. Research findings on the safety of low levels of drinking during pregnancy are by far inconclusive. Some of them have an association between childhood behavioral problems and light drinking (Sayal et al 2007 and Sood et al 2001). Some warn that only two glasses of alcohol a week could interfere with the development of the nervous system of the fetus with lasting effects. However, these findings have been opposed by systematic reviews that claim that there is no consistent evidence on the negative effects of light drinking across a range of outcomes, both on learning outcomes of childhood behavior. At the extreme end, some of these studies do not encourage total abstinence from alcohol by promising a slight developmental advantage for children who are exposed to alcohol before birth. The methodology The study will take a qualitative approach to the problem of fetal alcohol exposure. This method was chosen because the study does not aim at revealing the rates of alcohol consumption among pregnant women but the visible effects of this drinking on the babies born. It is not possible to tell by a simple glance, a child exposed to alcohol before birth while excluding the effects of other things like sickness, genetics, poor learning environment among others. Because of this, the study will require the identification of women and their children who will be direct participants. The participants will be drawn from women attending antenatal care but not for the first time. The study will target women expecting their second, third or fourth child. This is important because it will allow a recap of the drinking trends among pregnant women and the motivation behind it while also facilitating a collection of information on the effects of prenatal alcohol exposure to children. The study will however, target mothers whose other children are two years and above. This will allow the coverage of children in preschool and elementary levels of education. This sample of children will help to take into account time constrains. The study will be completed within five months. This means there will be no time to make a long-term study that will entail the identification of a given set of children before birth and making a follow-up study on their intellectual, behavioral physical and emotional development after their births for a about 1-3 years or more. Data required for the study will be obtained through self-report interviews and questionnaires. A semi-structured questionnaire will be designed in order to standardize the data collection process. All the participants will be able to choose to respond by filling a semi-structured questionnaire or engage in semi-structured personalized face-to-face or telephone interviews. Every data collection session is expected to last 20-40 minutes. Individual interviews will be conducted in a place preferred by each of the participants. This is important in assuring them confidentiality, anonymity and giving them a chance to express themselves freely in a private non-threatening environment. Telephone interviews will be important in attracting participation by women who could fear to engage in face-to-face discussions conducted in unfamiliar locations. In order to increase the validity of self-report data, this data will be collected in the context of a nonjudgmental, ongoing, trusting and respectful relationship that women engage with a social service provider or a health care. During the actual study, mothers will be required to describe the quantities of alcohol they took during their previous pregnancies and the trends of this during the first, second and third trimesters of the pregnancy. They will then be guided to explain the emotional, behavioral, intellectual and physical development of the children born out of these pregnancies. Upon parental consent, children mentioned by these women will then undertake a series of tests that will evaluate their emotional, behavioral and intellectual development. For purposes of this study, a drink will be defined as a half-pint of beer, a small glass of wine or a single serving of a hard alcohol. Sampling Method Sampling of the participants will be done randomly. This method is important given that the study relies on voluntary participation and it takes into consideration the sensitivity of the study. The study targets at least 100 participants aged 23-40 and these will be recruited from hospitals and community organizations. Information about the nature and aims of the study will be distributed by the hospital and community organizations’ staff through pre-interview scripts. Women who will be willing to participate in the study will be required to give their informed consent by signing and sending back their consent forms. This group will form the study sample. The sampling procedure is important in avoiding sampling biases. Children will be a critical group of active participants. Child participants will be recruited through their parents. This will ensure that this sample is precise, valid and more relevant compared to recruiting them from school records. Data analysis The study will employ qualitative data analysis in particular, narrative analysis. This method is more relevant to this study given that the study mainly focuses personal description of drinking experiences by mothers and their observation of the children born to them. This means that most of the information that will be received will be in narrative form and will be particular to each participant. Ethical considerations The study will take into various ethical considerations. Ethical regulations and guidelines will be observed to make sure study is conducted in an ethical manner. The study for example will take into consideration the need for confidentiality and informed consent. Because of this, only participants who will be fully aware of the nature and aims of the study will be allowed to participate in the study and this should be confirmed by the signing and returning of consent forms. The pre-interview script will precisely and fully explain the nature and aims of the study to ensure that all sensitive information is given only with the full informed consent of each participant. The questions to be used will be thoroughly reviewed to ensure they comply with ethical standards. For example, the questions should not be offensive or intrusive. Before the study, all the participants will be fully informed of their freedom to withhold any information they feel is confidential or pull out of the study at any time they are no longer free and comfortable to participate (BSC 2006 s4 (iii)). The use of self-reports to collect this type of data could be limited by the, feelings of guilt and shame, social stigma and/or fear of repercussions, including child welfare involvement and incarceration. In order to take care of this, the participants will be assured of a high level of confidentiality and anonymity before, during and after the study. Participants will not be required to give their names or the names of their children. Instead, they will only be required to state their age, age of the child and other relevant information. All participants will be assigned numbers for identification purposes. During and after the study, any personal data revealed by the participants will not be disclosed to other persons or organizations. Time scale/plan of work The study will take a period of five months. This duration allow an adequate time for commissioning the study, inviting participants and allowing them time to confirm their participation. Data collection and analysis will also be done within this period. The first month will be used to for preliminary preparations and literature review. Literature review, invitation of participants and the compilation of the list of participants will be done in the second and third months of the study. The third and fourth months will be used to collect data and the fifth month will be used to analyze the data collected, edit the report and make a presentation of the report. S/No. Activity 1 2 3 4 5 Preliminary preparations Literature review Sample invitation and participant list compilation Data collection Data Analysis Report Writing Report Editing Report presentation Conclusion The effects of heavy drinking are quite evident a lot of research having been conducted in relation to the subject. This study will focus on the effects of moderate drinking on pregnant women based on a survey of adult women. With a lot of hope, the survey will establish the effects of moderate drinking among pregnant adolescent girls and the motivations behind such behaviour. Furthermore, the study will reveal the effects of such behavior on the child’s development. References Abel, E. & Sokol, R. 1987. Incidence of foetal alcohol syndrome and economic impact of FAS-related anomalies. Drug Alcohol Depend, (1), pp 51–70. Alvik, A., Haldorsen, T., Groholt, B. et al. 2006. Alcohol consumption before and during pregnancy comparing concurrent and retrospective reports. Alcohol Clin Exp Res, (3), pp 510–515. Andreasson, S. & Allebeck, P. 2005. Alcohol as medication is no good. More risks than benefits according to a survey of current knowledge. Lakartidningen, (9), pp 632–637. British Society of Criminology. 2006. “Code of Ethics for Researchers in the Field of Criminology.” Viewed 16th April, 2012, www.britsoccrim.org/ethical.htm Burden, M., Jacobson, S., Sokol, R.et al.2005. Effects of prenatal alcohol exposure on attention and working memory at 7.5 years of age. Alcohol Clin Exp Res, (3), pp 443–452. Gray, R. & Henderson, J.2006. Review of the fetal effects of prenatal alcohol exposure: report to the Department of Health, National Perinatal Epidemiology Unit, University of Oxford. Oxford. Hill, S., Lowers, L., Locke-Wellman, J. et al. 2000. Maternal smoking and drinking during pregnancy and the risk for child and adolescent psychiatric disorders. J Stud Alcohol, (5), pp 661–668. May, P., Fiorentino, D., Gossage, P. et al. 2006. Epidemiology of FASD in a province in Italy: Prevalence and characteristics of children in a random sample of schools. Alcohol Clin Exp Res, (9), pp 1562–1575. Rickards, L., Fox, K., Roberts, C., Fletcher, L. & Goddard, E. 2004. Living in Britain: Results from the General Household Survey, no 31. The Stationery Office. London. Ronis, M., Wands, J., Badger, T. de la Monte, S., Lang, C., & Calissendorff, J. 2007. Alcohol-induced disruption of endocrine signaling. Alcohol Clin Exp Res, (8), pp 1269–1285. Sampson, P., Streissguth, A., Bookstein, F. et al. 1997. “Incidence of fetal alcohol syndrome and prevalence of alcohol-related neurodevelopmental disorder.” Teratology, (5), pp 317–326. Sayal, K. Heron, J. Golding, J. & Emond, A. 2007. Prenatal alcohol exposure and gender differences in childhood mental health problems: a longitudinal population-based study. Pediatric (2), pp 426-434. Sokol, R., Delaney-Black, V. and Nordstrom, B. 2003. Fetal Alcohol Spectrum Disorder. JAMA, (22), pp 2996-2999. Sood, B. Delaney-Black, V., Covington, C., Nordstrom-Klee, B., Ager, J., Templin, T., Janisse, J., Martier, S. & Sokol, R. 2001. Prenatal alcohol exposure and childhood behavior at age 6 to 7 years: I. dose-response effect. Pediatrics, (2), pp 34. Ulleland, C. (1972). The offspring of alcoholic mothers. Ann. N. Y. Acad. Sci, (197), pp 167–169. Read More